Our Oncology Disease Management Programme supports members with cancer. The team consists of highly skilled healthcare professionals who work in conjunction with your doctor to ensure that the treatment you receive is both clinically appropriate and cost-effective. Our team is also supported by a number of oncologists and haematologists from the private, public and academic sectors.

What does the programme include?

Our Oncology Disease Management Programme gives you the following benefits:

• Access to the Independent Clinical Oncology Network (ICON): We’ve contracted with ICON, an organisation that includes 75% of all practicing oncologists in South Africa in order to provide your oncology treatment. For more details of the ICON Network, visit www.cancernet.co.za or call your Oncology Case Manager on 0860 100 572.
• Coverage for chemotherapy, radiotherapy and associated medicine: We’ll pay for chemotherapy and medicine directly associated with the treatment of cancer, provided a valid authorisation has been obtained. Treatment for conditions not directly related to the treatment of the cancer (e.g. depression) as well as treatment for the long-term conditions that may develop as the result of chemotherapy or radiotherapy will be funded from an alternative benefit (e.g. the Chronic Disease Benefit or your day-to-day benefit).
• Consultations and visits: These will be covered while you have either an active chemotherapy or radiotherapy authorisation. Prior to starting treatment and once treatment has been concluded, consultations are paid from the day-to-day benefit.
• Pathology: We’ll cover oncology-related pathology claims while you’re receiving either chemotherapy or radiotherapy and for 12 months post treatment.
• Radiology: We’ll cover general oncology-related radiology claims while you’re receiving either chemotherapy or radiotherapy treatment, and for 12 months post treatment.
• Specialised radiology (e.g. CT scans, MRIs, angiography, radio-isotopes): These procedures require a separate pre-authorisation, and will be paid from the core benefit bundle.
• PET scans: You can have up to two PET scans per family per year, restricted to staging of malignant tumours.
• Surgery and hospitalisation: These claims will be paid from the core benefit bundle, subject to you obtaining a valid authorisation from the Hospital Authorisation Centre.
• Stoma therapy: This will be paid from OHEB first (if your option has an OHEB) and once depleted, from the core benefit bundle. Pre-authorisation is not required.
• Terminal care and private nursing: As part of our oncology benefit, the Terminal Care Benefit will cover accommodation in a hospice or terminal care facility for the care of patients in terminal stages of life (subject to a limit). You’ll need to get pre-authorisation from the Hospital Authorisation Centre. Private nursing will be paid from the Alternatives to Hospitalisation benefit, where this is available.

How to access this benefit
If you’re a Fedhealth member and want to access the oncology benefit, you’ll need to get pre-authorisation. This process uses a set of cancer guidelines and protocols that are continually updated as new products are launched and new treatment protocols are established.

Need more information?
Read more about Fedhealth’s oncology benefit here.

Fedhealth allows upgrades to a higher option at any time of the year within 30 days of diagnosis of a dread disease or other life-changing event such as a pregnancy. This means the peace of mind that you’ll be covered whatever life throws at you!

The statistics are concerning: 30% of South Africans will suffer from a mental health condition in their lifetime, and 76 to 85% of people in low- and medium-income countries with severe mental disorders receive no treatment. To help address mental health issues amongst its members, Fedhealth offers the Mental Health Programme and the Emotional Wellbeing Programme.

Mental Health Programme

Mental health can be seen as the centre of all health, characterised by integral relationships with a person’s physical, social, workplace and financial wellbeing.

Fedhealth’s Mental Health Programme, available to qualifying members who have been diagnosed with mental health conditions including depression and bipolar disorder, uses innovative solutions for member empowerment and relies on social, family and workplace support.

It promotes:

• Greater reduction in mental health symptoms
• Greater rates of care for mental health
• Improvement in quality of life
• Less functional impairment
• Better patient satisfaction
• Better provider satisfaction
• Lower total healthcare costs in the medium- and long-term
• Significant benefits in terms of absenteeism reduction

Any Fedhealth member or beneficiary may enquire whether they qualify for enrolment in the Fedhealth Mental Health Programme. The qualifying beneficiary must contact Fedhealth, as the Scheme needs member consent and involvement for programme enrolment.

The Fedhealth Mental Health Programme also integrates with workplace employee assistance programmes, and establishes a bi-directional referral process between them. Integrated reporting will help measure mental health impact and outcomes, particularly in terms of productivity, which is considered a sensitive measure of mental health interventions.

Contact us: The share call number is 0860 002 153 – follow the prompts to the Disease Management Programme and select the Mental Health Programme, or send an email to mentalhealth@fedhealth.co.za for more information and to see whether you qualify.

Emotional Wellbeing Programme

Fedhealth’s Emotional Wellbeing Programme, available to all Fedhealth members and beneficiaries, offers telephonic support to help members cope with the everyday stress of life.

This programme offers Fedhealth members:

• A dedicated call centre for personal and occupational coaching, trauma, legal wellbeing and financial wellbeing
• Wellbeing communications on relevant and trending psychosocial, financial and legal wellbeing themes to ensure optimal wellbeing and encourage healthy decision-making
• Access to a multi-disciplinary team of wellbeing professionals through Fedhealth hosted webinars and social media engagements including live chats
• Referral to in-person coaching at a reduced rate for Fedhealth members
• Care coordination and management to assist with risk screening to facilitate convenient access to the appropriate service
• Tele-coaching where a personal coach provides immediate, professional tele-coaching on psychosocial, financial and legal issues

The programme will be run by a care centre and will be available 24/7 through various channels such as telephone, email, SMS and a call-back facility. Call 087 365 8664 to access this service or click here to download the PDF version of this benefit.

Through the Mental Health Programme and the Mental Wellness Programme, Fedhealth helps our members to take charge of their mental health and live fuller, more rewarding lives.

The Fedhealth Birth and Baby Benefit combines three main benefits:

1. Fedhealth Baby Programme

All pregnant beneficiaries can register for the FREE Fedhealth Baby Programme 12 weeks into their pregnancy and look forward to:

A Fedhealth baby bag

A gorgeous Fedhealth baby bag is usually sent to the mom-to-be a month after registration. It’s packed with quality goodies like baby care products, nappies, a pregnancy book and more.

Vouchers and discounts
Discounts and vouchers for the best baby brands including:

• 40% off Living & Loving magazine
• 10% off Preggi Bellies exercise classes
• 15% off safety products for babies and toddlers from 4aKid
• From 10 to 25% off Chelino strollers, camp cots and car seats
• 25% off Baby Kaboosh sleeping bags
• 25% off Babynastics DVD
• 20% off Boobi Blankets
• 25% off Lots 4 Tots baby play mats
• 20% Baby Legends HUGSEEZ Baby Wrap Carrier
• Free immunisation e-mail reminders from Tum2mom.

Read more about the Fedhealth Baby Programme.

Education and support

Fedhealth Baby members receive ongoing communication and education in the form of emails and e-letters (to mom and dad), health profiling for each trimester, monthly callouts for high-risk members, email registration for chronic risk communications, access to our 24-hour Medical Advice Line and cover for doula (birth coach) assistance during natural childbirth, together with a new birth card.

Baby Advice Line

A dedicated 24-hour medical advice line for any pregnancy concerns, pre- or post-birth.
Call 0861 116 016 or email info@babyhealth.co.za for more information and to apply now.

2. Post-natal midwifery benefit

We will pay for four consultations in- and out-of-hospital per pregnancy at 100% of the Fedhealth Rate.

3. Doula for labour support during natural childbirth

We allow R1 300 for a doula per delivery.

In any medical emergency, it is important for injured people to reach the most suitable care facility in the shortest possible time. The care received in the period immediately after the incident together with proper care in hospital will determine the patient’s survival and recovery. Lack of proper treatment may worsen injuries and cause permanent damage and/or disability.

Europ Assistance provides a 24-hour medical advice and evacuation service, which includes the co-ordination and management of emergency transport. It is available to the members according to the benefit rules.

THE MEDICAL EMERGENCY BENEFIT

Medical advice in any emergency situation
Qualified nurses will give telephonic advice in any emergency situation. This means that you will have information that may save a life while the medical team is on its way to the scene of the incident.

Emergency road or air response
Emergency vehicles or other appropriate means of transport will be dispatched immediately. The vehicles and aircraft are manned by professional healthcare personnel, and are equipped with the most appropriate equipment needed for medical emergency treatment.

Most appropriate facility and ambulance transfers
Initially you will be transferred to the nearest, most appropriate medical facility for treatment. Unless air transport is essential for survival, transfers to medical facilities will be by road ambulance. When you are well enough to return home or to a medical care facility closer to home, this will be arranged. The benefit is limited to patients who require medical assistance at such time.

Delivery of medication/blood
If medicines to treat you or your family are not available in an emergency, Care Assist will arrange for medicine or blood products to be delivered to the medical facility where you are being treated.

Patient monitoring
Europ Assistance will monitor your condition constantly until you have been moved safely to a medical facility.

Care for stranded minors or frail companions
Should minors or frail companions be left stranded due to a medical emergency situation, Europ Assistance will arrange for a companion to accompany them to a place of safety.

To read more on the Emergency Treatment benefit, download the full document.

In any medical emergency, it’s very important that you get the proper care within the shortest possible time. The care you receive immediately following the emergency followed by the care you receive in hospital has a huge impact on your recovery. If you don’t get proper treatment, your injuries can worsen, and you could even be left with permanent damage and/or disability.

As a Fedhealth member, you’ll get the following emergency benefits as part of your medical aid:

• 24-hour medical advice and evacuation: This is provided by Europ Assistance, and includes the co-ordination and management of emergency transport.
• Medical advice: Qualified nurses will give telephonic advice in any emergency situation. This means that you will have information that may save a life while the medical team is on its way to the scene of the incident.
• Emergency road or air response: We’ll dispatch emergency vehicles or any other appropriate means of transport immediately, giving you even quicker medical help. These vehicles and aircraft are manned by professional healthcare personnel and are equipped with the most appropriate equipment needed for medical emergency treatment.
• Most appropriate facility and ambulance transfers: Initially you’ll be transferred to the nearest, most appropriate medical facility for treatment. Unless air transport is essential for survival, transfers to medical facilities will be by road ambulance. When you are well enough to transfer to a medical care facility closer to home, this will be arranged.
• Delivery of medication/blood: In an emergency, if medicines to treat your or your family are not available locally, Care Assist will arrange for medicine or blood products to be delivered to the medical facility where you are being treated.
• Patient monitoring: Europ Assistance will monitor your condition constantly until you’ve been moved safely to a medical facility.
• Care for stranded minors or frail companions: Should minors or frail companions be left stranded due to a medical emergency situation, Europ Assistance will arrange for a companion to accompany them to a place of safety.

To read more on the Emergency Treatment benefit, download the full document.

When you need to see a doctor, we’ve got you covered with unlimited network GP visits that are paid from Risk (core benefit bundle) once your day-to-day benefit has been depleted.

There’s a GP near you

We currently have more than 4 600 network general practitioners across the country. This means that 96% of our members live within a 10km radius of a network GP.

How it works: Comprehensive options

On our comprehensive options, should you make use of a network GP, the full cost of the consultation is paid from OHEB (on maxima PLUS) and never from your Savings, with full accumulation at the negotiated rate to your threshold level. Once OHEB is depleted, GP consultations will then be paid in full from Risk (by the Scheme), and the benefit then also becomes UNLIMITED! That means you seeing your doctor as often as you like and never having to pay for a doctor’s consult from your own pocket again – provided you make use of a network doctor.

On flexiFED 4, your GP visits will always be paid from Risk, never from Savings

On flexiFED 4, consultations with a Fedhealth Network GP are always cover from the core benefit bundle and never from your day-to-day benefit (Savings/ MediVault and Wallet).

It’s important to note that it’s your choice to use whichever doctor you prefer. But should you choose to use non-network GPs, the full consultation fee will then be refunded from your day-to-day benefit and will accumulate to your threshold level at 100% of the Fedhealth Rate.

How it works: flexiFED options

On flexiFED 1, flexiFED 2 and flexiFED 3 we offer the following Network GP benefit:
Consultations at a Fedhealth Network GP will be covered from your day-to-day benefit. Once your day-to-day expenses have accumulated to the Benefit Maximiser threshold level, Fedhealth will cover unlimited GP visits at a nominated Fedhealth Network GP.

How to nominate a GP

Each person on your medical aid can nominate a different GP, but must use this GP for all consultations. Please phone the Fedhealth Customer Contact Centre on 0860 002 153 to nominate a GP for each person on your medical aid. You will be allowed to change GPs every six months.

Find a GP near you

Locating a contracted GP is a simple online process, simply click here to find a GP near you.

On Fedhealth, we give you more choice, flexibility and control over your medical aid through the revolutionary MediVault and Wallet facility. Now, you don’t have to pay for your day-to-day savings upfront before you’ve even used them!

So how does it work? Based on your option and family composition, you’re allocated a certain amount of money in your MediVault for day-to-day medical expenses. When you need funds for visiting the GP for example, you either transfer the full amount, or increments of R600, into your Wallet.

You will only pay back the money that has been transferred from your MediVault to your Wallet – interest-free over 12 months.

This flexible facility allows you to pay a lower monthly contribution by choosing when and if you use your MediVault and Wallet. If you don’t use it, you don’t pay for it!

Tobacco use is one of the biggest public health threats the world has ever faced, and kills up to half of all users. There are over one billion smokers worldwide and eight million in South Africa.

Stopping smoking is the single most important decision one can make for one’s health. The benefits of stopping smoking are almost immediate, but quitting is not easy because nicotine is highly addictive. Smoking is also associated with social activities such as drinking or eating and psychological factors such as work pressure, anxiety and body weight concerns.

The numbers

Research shows that over 70% of smokers would like to give up smoking, and a further 30% go on to attempt to stop each year, however, less than 3% successfully quit cold turkey. Further clinical reviews indicate that the most effective smoking cessation intervention is a combination of behaviour change techniques, medication and support.

GoSmokeFree is available to all members

Fedhealth encourages members who smoke on all options to sign up for the GoSmokeFree service that’s available at 200 pharmacies countrywide, including Dis-Chem, Clicks, Pick n Pay and independent pharmacies. All smokers have access once per beneficiary per year to have the GoSmokeFree consultation paid from Risk. The service comprises a pre-quit assessment and five support sessions, and features an individual plan to help the member to quit smoking.

Pre-quit assessment

• Nicotine dependency test
• Carbon monoxide level check
• Motivation to quit
• Behaviour modification
• Medication discussion
• Set quit date
• GoSmokeFree diary

Support sessions (five)

• Confirm quit date
• Quit date preparation
• Four post-quit follow-up sessions
• Carbon monoxide level check
• Behaviour change support
• GoSmokeFree quit certification

Where members may need nicotine-replacement therapies as part of their plan, the Scheme will allow them to claim certain products from their Savings. The GoSmokeFree service forms part of the Foundation benefit. The GoSmokeFree Smoking Cessation Programme is available at various pharmacies throughout South Africa using a trained Nursing Sister or Pharmacist – see gosmokefree.co.za to find out more and locate the nearest participating pharmacy. 

Please call 0860 002 153 for all general enquiries and customer care assistance, including benefit and limit confirmation and document requests, as well as hospital authorisations, chronic medication enquiries and oncology-related authorisations.

To download a copy of this benefit – click here 

Countless studies have shown that being obese or overweight has dire health consequences. It substantially increases the risk of morbidity from at least 15 conditions including hypertension, abnormal cholesterol levels, Type-2 Diabetes, coronary artery disease, stroke, gallbladder disease, osteoarthritis, sleep apnoea and respiratory problems, as well as cancers of the endometrium, breast, prostate, and colon. Being overweight also places considerable strain on the joints, often resulting in orthopaedic surgery.

And if this isn’t enough cause for concern, body weight is associated with an increase in mortality from all causes. In addition, obese patients may suffer from social stigmatisation and discrimination, coupled with mental health issues.

This has led Fedhealth to introduce its Weight Management Programme – a programme expertly designed for qualifying Fedhealth members with a high BMI and waist circumference.

Members will participate in a 12-week, biokineticist-led intervention that will give them access to a dietician and behavioural psychologist with the goal to lose the excess weight and lead healthier, more rewarding lives. Once the programme is completed, ongoing advice and monitoring will also be made available to the member.

Who qualifies for the programme?

Fedhealth members with the following parameters will be eligible for the programme:

• BMI ≥ 30 kg/m², or
• Men with a waist circumference ≥ 102 cm, or
• Women with a waist circumference ≥ 88 cm, or
• Other cases identified by a GP or BASA biokineticist supported by a motivation e.g. members with a BMI between 25.0 kg/m² and 29.9 kg/m² with diabetes and comorbidities.

How it works

The weight management programme runs over 12 weeks (three months) and entails:

1. Once a member or beneficiary has been identified as suitable for the weight management intervention, the GP is notified electronically that their patient has been enrolled on the weight management programme;
2. Management by a BASA biokineticist which includes:
• 9 exercise sessions with a biokineticist which can be either individual or group exercise sessions
• 3 reassessment sessions with a biokineticist
• Referral to a dietician for a consultation and a follow up
• Referral to a psychologist for one consultation; and
• The biokineticist submits electronic reports to the member’s GP and Fedhealth after each interaction.
3. Self-monitoring; and
4. At the end of the programme, Fedhealth will make contact with the member in order to obtain feedback and conduct a discussion on health outcomes. Furthermore, the member will be advised about ongoing assistance available to ensure sustained weight management.

Through the weight management programme, Fedhealth hopes to lead more of our family members towards leaner, healthier and more fulfilled lives. To download this document, click here.

What is the child rate benefit? 

As one of our key benefits, Fedhealth offers child medical aid rates for financially dependent children up to 27 years of age. This means that student dependants pay rates applicable to children of the main member or spouse, provided that child is unmarried and not earning more than the maximum social pension.

As an example, on the flexiFED 4 plan, child rates mean you could save up to R16 000 per year on medical aid contributions for each of your children, until they turn 27. And the money you save? You can use it towards tuition or accommodation fees.

What is the definition of a dependant? 

Your spouse, partner, children, or other family members who rely on you for financial care and support, may be registered as your dependants. Want to know more? Read more on dependants.

It’s our mission to offer you the right benefits at the right stage of your life. Regardless of where you’re at – single and ready to mingle, settled and in love with your babies, or sending a kid off to varsity – our medical aid benefits will support you and your family every step of the way.

Our options are structured to address your unique healthcare needs as they arise. From generous maternity and childhood benefits for young families, to extensive chronic benefits for older members, or treatment in a casualty ward after falling off a mountain bike for daredevil members… we’ve got you covered

At Fedhealth we firmly believe that prevention is better than cure. That’s why we pay for women’s-, children’s-, cardiac-, over 50s-, and general health risk assessments and screenings from the core benefit bundle (Risk), depending on your option.

Our screening benefit was created to stretch day-to-day benefits by paying even more from the core benefit bundle as well as protect you at every life stage. The Scheme pays for screenings for women’s, children’s, cardiac, as well as general health (like an annual flu vaccine). And on our comprehensive options, this benefit even includes screening and preventative programmes for older members.

Here’s what the benefit covers:

WOMEN’S HEALTH

We cover mammograms (breast cancer screening) for those aged 50-74, giving you one mammogram every three years. We also cover pap smears* (for cervical cancer screening) for those aged 21- 65 years – with a limit of one pap smear every three years. myFED members do not receive this screening benefit.

* Please note that liquid based cytology will be reimbursed up to the rate for a standard pap smear.

CHILDREN’S HEALTH

For beneficiaries up to 12 years old, every aspect of child immunisation is paid from the core benefit bundle, resulting in a considerable amount of day-to-day savings. This applies to ALL options (with the exception of myFED, which does not offer the Screening Benefit).

Download the PDF to read which immunisations are covered.

CARDIAC HEALTH

For beneficiaries aged 20 and older, Fedhealth pays for a full lipogram conducted by a pathology lab. This is not a pharmacy-based screening involving a simple finger prick test, but a comprehensive lipogram offered to members by pathology professionals. Cholesterol screening is offered on all options (excluding myFED) – with a limit of one lipogram every five years.

SENIOR HEALTH

Pneumococcal Immunisation
For beneficiaries aged 65 and older, this benefit covers the cost of one Pneumococcal Immunisation per lifetime. The benefit applies to all plans except myFED.

Bone Densitometry
For female beneficiaries aged 65 and older and men aged 70 and older, the Scheme pays for one Bone Densitometry screening per lifetime on maxima PLUS and maxima EXEC only.

Colorectal Cancer Screening – Faecal Occult Blood Test
For all beneficiaries aged 50-75, Colorectal Cancer Screening is also covered by the Scheme once every two years on all options except myFED.

GENERAL HEALTH

Flu vaccinations: The Scheme pays for an annual flu vaccine from Risk for all beneficiaries on all options.

You don’t need any pre-authorisation for the screening benefit, so you can get it done and claim back from us later. This benefit was created with you in mind, and the benefits and savings are truly significant.

To read more on the screening benefit, download the full document.

24-hour Nurse Line on 0860 333 432

Before making that appointment at the doctor or rushing off to the emergency room, get the right medical advice that can save you time and money. Our experienced nursing staff can answer your questions about unfamiliar symptoms, medical and drug information or common home remedies for dealing with sick children, nutrition and diet, or more sensitive topics. All queries are treated in a confidential and professional manner.

Our nurses can assist by:

• Assessing your symptoms and refers you to the appropriate type of healthcare
• Providing you with important health knowledge on any aspect of health from surgery to detailed information on varying problems such as lice, moles, measles or mumps
• Providing expert counselling on any chronic ailments or diseases to help you live with the condition or that of a loved one
• Providing expert information on medicines, including purpose, side effects, and contra-indications.

Call the Fedhealth Nurse Line for:

Emergency medical advice
In the event of a medical emergency, the nurses will provide appropriate first aid advice to you until medical help arrives.

Assessing day-to-day symptoms
The nurses can give advice on various common illnesses such as colds. Although unable to diagnose, the nurses have access to a computer database and their own clinical experience to guide you through various home care advice strategies.

Important health knowledge
The nurses can explain medical terms, test results and procedures to you, and give dietary information.

Drug database
A complete drug database is available to assist you with information on a specific drug, its contra-indications, when it should be taken, and any dietary specifications linked to the usage of the drug.

Poisoning
A database with poisoning protocols is available to assist you. An ambulance will be dispatched if the patient is critical and in need of immediate medical care.

Health counselling
The nurses can offer you a better understanding of various chronic ailments such as cancer, HIV/Aids, diabetes or asthma, and offer specific treatment to help the patient, and those around them, cope better with their circumstances.

Ailments covered include:

HIV/Aids and cancer
The registered nurses are amongst the leading counsellors in this field and can assist you in managing and living with these conditions.

Addiction
All the nurses are trained counsellors and can offer advice on coping skills or refer you to appropriate medical care clinics.

Stress management
The nurses can assist stressed members on a daily basis by offering counselling, advice and relaxation techniques. Should the nurse realise that there is a need for further assistance, the patient will be referred to a doctor for initial assessment and further treatment.

Teen Line
The nurses offer advice to teenagers and counsel them on physical, emotional and sexual questions and problems they may be experiencing. The caller is spoken to in his/ her home language and advice given includes:

• Drug related questions
• Coping with studies
• Peer pressure
• Living with HIV/ Aids

Abused or neglected children are also encouraged to phone the Teen Line, as the nurses are trained to advise on these issues in a sensitive, constructive and confidential way. Following the assessment of symptoms and if the nurse concludes that there is some kind of abuse, they will:

• Persistently guide the victim to act in their own best interests;
• Encourage them to speak to their parents, teachers, church leader or other adult they trust;
• Make them understand that abuse needs to be reported;
• Refer them to the social welfare department.

To read more on the 24 Hour Nurse Line benefit, download the full document.

This service is provided free of charge to all Fedhealth members. Don’t wait, call at any time on 0860 333 432.

We offer the following comprehensive managed care programmes for members with specific healthcare needs:

Aid for AIDS (AfA)

HIV, although serious, is a manageable chronic disease just like any other chronic condition. There have been major advances in the understanding of the disease as well as developments in its treatment and management. An HIV positive diagnosis is no longer a death sentence.

Fedhealth’s Aid for AIDS programme helps members who are HIV-positive manage the condition.

The benefits of AfA (over and above the payment of the necessary medicine and pathology claims), include clinical and emotional support on how to manage the condition. Members are routinely called by counsellors to check how they are doing, and receive reminders when they are due for blood tests.

Fedhealth provides cover for an HIV test (which includes pre- and post-test counselling) on all its options, and we encourage employers to ensure that their staff is tested and know their status so that they can get the appropriate assistance early.

Research has shown that patients who take their medicine correctly improve their body’s defence mechanism and will have reduced incidence of opportunistic infections (infections due to a weakened immune system).

Contact us: Call the HIV Disease Manager on 0860 100 646 or email afa@afadm.co.za for a confidential conversation.

Oncology Disease Management

Our Oncology Disease Management Programme supports members with cancer. Our team consists of highly skilled healthcare professionals who work in conjunction with your doctor to ensure that the treatment you receive is both clinically appropriate and cost-effective. They are also supported by a number of oncologists and haematologists from the private, public and academic sectors.

What does the programme include?

Our Oncology Disease Management Programme gives you the following benefits:

• Access to the Independent Clinical Oncology Network (ICON): We’ve contracted with ICON, an organisation that includes 75% of all practicing oncologists in South Africa in order to provide your oncology treatment. For more details of the ICON Network, visit www.cancernet.co.za or call your Oncology Case Manager on 0860 100 572.
• Coverage for chemotherapy, radiotherapy and associated medicine: We’ll pay for chemotherapy and medicine directly associated with the treatment of cancer, provided a valid authorisation has been obtained. Treatment for conditions not directly related to the treatment of the cancer (e.g. depression) as well as treatment for the long-term conditions that may develop as the result of chemotherapy or radiotherapy will be funded from an alternative benefit (e.g. the Chronic Disease Benefit or your day-to-day benefit).
• Consultations and visits: These will be covered while you have either an active chemotherapy or radiotherapy authorisation. Prior to starting treatment and once treatment has been concluded, consultations are paid from the day-to-day benefit.
• Pathology: We’ll cover oncology-related pathology claims while you’re receiving either chemotherapy or radiotherapy and for 12 months post treatment.
• Radiology: We’ll cover general oncology-related radiology claims while you’re receiving either chemotherapy or radiotherapy treatment, and for 12 months post treatment.
• Specialised radiology (e.g. CT scans, MRIs, angiography, radio-isotopes): These procedures require a separate pre-authorisation, and will be paid from the core benefit bundle.
• PET scans: You can have up to two PET scans per family per year, restricted to staging of malignant tumours.
• Surgery and hospitalisation: These claims will be paid from the core benefit bundle, subject to you obtaining a valid authorisation from the Hospital Authorisation Centre.
• Stoma therapy: This will be paid from OHEB first (if your option has an OHEB) and once depleted, from the core benefit bundle. Pre-authorisation is not required.
• Terminal care and private nursing: As part of our oncology benefit, the Terminal Care Benefit will cover accommodation in a hospice or terminal care facility for the care of patients in terminal stages of life (subject to a limit). You’ll need to get pre-authorisation from the Hospital Authorisation Centre. Private nursing will be paid from the Alternatives to Hospitalisation benefit, where this is available.

How to access this benefit
If you’re a Fedhealth member and want to access the oncology benefit, you’ll need to get pre-authorisation. This process uses a set of cancer guidelines and protocols that are continually updated as new products are launched and new treatment protocols are established.

Need more information?
Read more about Fedhealth’s oncology benefit here.

Mental Health Programme

Mental health can be seen as the centre of all health, characterised by integral relationships with a person’s physical, social, workplace and financial wellbeing.

Mental illness has direct consequences on behaviour, quality of life and productivity. The presence of mental illness increases the risk of disability and premature mortality from other diseases such as cardiovascular disease, diabetes and HIV/AIDS. While patient activation and empowerment is becoming an important focus area in the management of other chronic diseases, this may be a particularly difficult achievement in the patient with a mental disorder.

Fedhealth’s Mental Health Programme uses innovative solutions for member empowerment, and relies on social, family and workplace support.

It promotes:

• Greater reduction in mental health symptoms
• Greater rates of care for mental health
• Improvement in quality of life
• Less functional impairment
• Better patient satisfaction
• Better provider satisfaction
• Lower total health care costs in the medium and long term

Adherence to and active participation in treatment is required from patients to achieve desired clinical outcomes.

Need more information?
Read more about Fedhealth’s Mental Health benefit here.

Contact us: The share call number is 0860 002 153 – follow the prompts to the Disease Management Programme and select the Mental Health Programme, or send an email to mentalhealth@fedhealth.co.za for more information and to see whether you qualify.

Conservative Back and Neck Rehabilitation Programme

Back pain is a common cause of morbidity and incapacity, and has a significant social and economic impact. It’s second only to headaches when it comes to painful disorders that affect humans.

Fedhealth has an established programme intervention for qualifying members suffering from back and neck problems. It’s built on the principle of active muscle reconditioning, supported by scientific clinical studies showing that exercise reduces pain and can normalise function in many instances.

The programme requires 30 hours of treatment and tangible benefits for the member include an increased quality of life, and the assurance that their employer, through Fedhealth, is providing them with the care that they specifically require.

Need more information?

Read more about Fedhealth’s Conservative Back and Neck Rehabilitation Programme benefit here.

Contact us:
The share call number is 0860 002 153 – follow the prompts to the Disease Management Programme and select the Conservative Back and Neck Rehabilitation Programme, or send an email to backandneck@fedhealth.co.za for more information and to see whether you qualify for participation in this programme.

Post-hospitalisation treatment for up to 30 days after discharge from hospital (such as physiotherapy, x-rays, pathology) – i.e. follow-up treatment for a full 30- day period is paid directly from Risk, to preserve your day-to-day benefit. Pre-authorisation must be obtained

Seven days of paid for take-home medication after discharge from hospital – provided the medication is dispensed by the hospital and reflects on the original hospital account.

Specialised radiology like MRI/ CT scans, pays from Risk no matter what option you’re on whether they are performed in- or out-of-hospital. A co-payment may apply on scans, depending on option. Does not apply to myFED

Trauma treatment at a casualty ward – whether admitted to hospital or not, emergency treatment, like stitches, is always paid from Risk and never from Savings. Co-payment applies depending on the option. Authorisation must be obtained

Cover for female contraception – including oral, patches, contraceptive rings, certain injectables as well as IUDs that include Mirena®, on all flexiFED and maxiFED options. On myFED, we cover oral contraception only subject to an approved list. *Must be prescribed by a GP or gynaecologist and not applicable to pills prescribed for acne

In-hospital dentistry for children under 7 – We cover the hospital and anaesthetist costs from the core benefit bundle while the dentist account comes from day-to-day benefits. Does not apply to flexiFED 1 and myFED

In times of emergency it’s only human to panic, which could make it difficult for Fedhealth members to get in touch with the Europ Assistance Contact Centre when it’s critical. A lack of airtime could also prevent members from getting in touch with us.

To resolve this, Europ Assistance has implemented the SOS Call Me service – a user-friendly call back service that means we will call members back when they need us at no cost to them. All Fedhealth members and their dependants can use this free service.

Members can select three options on the service:

1. Emergency Medical Services (EMS)
2. Nurse Line
3. MediTaxi

How to use the SOS Call Me service:

1. Members should save the number *130*3272*31# for EMS, Nurse Line and Medical Taxi as a contact on their phone (under Europ Assistance or a name they will remember for emergencies);
2. In an emergency, members must choose this number and select the service (EMS, Nurse Line or MediTaxi). An SMS will be sent to the Europ Assistance Emergency Contact Centre who’ll phone the member back within the agreed emergency timelines for each service: EMS – 120 seconds; Nurse Line – 2 hours; and MediTaxi – 2 hours before pick-up.

What makes this service so useful, is the fact that it’s easy to use, members can get assistance at the press of a button, it’s accessible on any mobile device, it means peace of mind and convenience, and it’s available 24/7 365 days a year.

To download a copy of this benefit – click here

MediTaxi is a medical taxi service available to qualifying Fedhealth members in Cape Town, Johannesburg, Pretoria and Durban.

Fedhealth members who’ve had hospital authorisations can access the 24/7 MediTaxi benefit to take them to follow-up doctor’s appointments – provided they’ve undergone an authorised operation or medical treatment that prevents them from driving.

MediTaxi provides transport from the member’s home to the approved healthcare service provider such as physiotherapists, doctors, specialists or a radiology practice, and includes the return trip.

Please note:

• Trips are limited to two return trips per member/beneficiary per annum.
• The pick-up or drop-off point must be in Johannesburg, Pretoria, Cape Town and Durban, and the total trip should not exceed 50km.
• The service is available to verified Fedhealth members. Europ Assistance SA will not request any medical information to support validation for the benefit.

Booking the MediTaxi service

When Fedhealth members phone to book a trip, they need to provide their a) membership number, b) date of operation, and c) healthcare provider’s details.

To access the MediTaxi benefit

• Members need to save the number *130*3272*31# for Emergency Medical Service (EMS), Nurse Line and MediTaxi as a contact on their phones (under Europ Assistance or a name they’ll remember for emergencies);
• When they need to book MediTaxi, members need to choose this number and select the service (EMS, Nurse Line or MediTaxi). An SMS will be sent to the Europ Assistance Emergency Contact Centre who’ll phone them back within the agreed emergency timelines for each service: EMS – 120 seconds; Nurse Line – 2 hours; and MediTaxi – 2 hours before pick-up.

Changing a booking time or location

If the member moves from the original booking location without notifying and confirming with the call centre, we may not be able to successfully deliver the service. It is the member’s responsibility to notify us within a reasonable timeframe of their intention of changing the pick-up location.

Pick-up and drop-off points

When members book MediTaxi, they will agree to a pick-up point. At the specified time and location, the call centre will notify them that the pick-up driver has arrived, and they will have 15 minutes to meet the designated driver. If there’s no response after 15 minutes, the call centre will notify them that the pick-up driver will be leaving and the trip will be cancelled. Cancellation terms apply.

Cancellation

Any bookings cancelled less than 60 minutes before the agreed collection time, will be billed at the full rate and deducted from the member’s total covered incidents.

Additional terms and conditions

MediTaxi will cover a maximum distance of 50km from point of pick-up to point of drop-off. If members wish to travel further from this point and capacity allows it, they will be charged accordingly, and payment terms will directly be facilitated by the DSP. Members are urged not to pay any gratuity to the provider rendering the service.

If members are not entirely satisfied with the service, they can log a call through the Europ Assistance call centre. We will provide the member with feedback following a full investigation.

We trust that this free service will help to make Fedhealth members’ recovery after a hospital event a little easier.

For a downloadable version of this document click here

Back pain is a common cause of morbidity and incapacity, and has a significant social and economic impact. It’s second only to headaches when it comes to painful disorders that affect humans.

Fedhealth has an established programme intervention for qualifying members suffering from back and neck problems. It’s built on the principle of active muscle reconditioning, supported by scientific clinical studies showing that exercise reduces pain and can normalise function in many instances.

The programme requires 30 hours of treatment and tangible benefits for the member include an increased quality of life, and the assurance that their employer, through Fedhealth, is providing them with the care that they specifically require.

Contact us:
The share call number is 0860 002 153 – follow the prompts to the Disease Management Programme and select the Conservative Back and Neck Rehabilitation Programme, or send an email to backandneck@fedhealth.co.za for more information and to see whether you qualify for participation in this programme.

To read more on the Conservative Back and Neck Rehabilitation Programme benefit, download the full document.

Our health risk assessments benefit aims to identify Fedhealth members who are at risk of developing lifestyle diseases like diabetes, high cholesterol and heart disease. Once identified, we either help them prevent the onset of these conditions by changing their lifestyles – or we help them manage their disease through practical advice and steps.

Health Risk Assessments are available to all Fedhealth members and entail:

1. Wellness screening

Wellness screenings can be done by nurses at wellness days, nurses at pharmacy clinics or by a registered Biokinetics Association of South Africa (BASA) biokineticist. They include blood pressure, BMI, waist-to-hip ratio (WHR), random glucose and random cholesterol (finger prick) tests.

2. Physical screening

Members may visit any BASA biokineticist to have their physical screening done. The screening includes resting heart rate, body fat percentage, peak expiratory flow rate, flexibility and fitness measurements. Specific risk factors for metabolic syndrome, Type-2 Diabetes and cardiovascular disease are identified through the screening, and personalised activity-related interventions are recommended which will also improve the member’s mental wellbeing.

The way forward

Once these steps have been completed, members receive a report with feedback on their overall health and wellbeing. The member will find out what their ‘heart age’ is – an easily understood indicator of their overall health. Members may be identified as part of the High Risk or Emerging Risk groups, and flagged as being at risk of developing a chronic lifestyle disease.

Should they agree to participate in disease management programmes, they may receive additional wellness intervention benefits. These interventions will be done by a BASA biokineticist, who will refer the member to dieticians, psychologists and general practitioners where applicable (with responsible promotion of Scheme benefits). With health risk assessments, Fedhealth is set on helping members lead more fulfilling lives by making important lifestyle changes.

To download a PDF version of this benefit, click here

Fedhealth is one of the only medical schemes that pay for post-hospitalisation treatment for up to 30 days after discharge from hospital.

Follow-up treatment for a full 30-day period after leaving the hospital is paid directly from Risk, so your day-to-day benefits are not depleted. This ensures that your treatment is completed properly, plus it protects your Savings.

What does the 30-day post-hospitalisation benefit cover?

• Post-hospital treatment up to 30 days from date of discharge for physiotherapy, occupational therapy, speech therapy, ultrasounds, general radiology and pathology.
• Treatment is covered at 100% of the Fedhealth Rate and includes complications that may arise from hospitalisation.

Treatment is limited to the hospitalisation benefit within 30 days following hospitalisation ONLY. The day that you are discharged counts as the first day of the 30 days of cover. Treatment is also subject to the relevant managed healthcare programme and prior authorisation.

The following conditions apply:

• You must pre-authorise treatment 48 hours prior to the treatment.
• Only treatment as a result of a hospital event will be covered.
• Only follow-up treatment related to the original diagnosis is covered.
• If the member does not pre-authorise treatment, the claim will then be paid from available day-to-day benefits (Savings and OHEB) or by the member directly.
• Applying for authorisation after treatment has been received will not be allowed.
• Treatment must be requested by the doctor who treated the patient in hospital.

To read what this benefit does not cover, as well as other details, please download this document.

Oral contraception, contraceptive rings, contraceptive patches and certain contraceptive injections as well as IUDs (including Mirena®), are covered from Risk on the following plans:

• maxima PLUS
• maxima EXEC
• maxima EXEC GRID
• flexiFED 4
• flexiFED 3
• flexiFED 2
• flexiFED 1

Oral and injectable contraceptives are covered on myFED.

If you get them at a pharmacy, GP or a gynaecologist, the cost will automatically be covered by the Scheme and funded from the core benefit bundle. Bear in mind that oral contraceptive prescriptions will only be funded from the core benefit bundle if prescribed for the purpose of contraception, and not for the purpose of treating acne or another skin condition. IUDs (including the Mirena®), are also paid from the core benefit bundle but this excludes the doctor’s consultation and the cost of the procedure, which will be paid from your day-to-day benefits.

If you’d like to find out which kinds of contraception are funded from the core benefit bundle and which are not, please download this benefit information here.

Fedhealth is one of the only schemes that pay for trauma procedures from Risk (core benefit bundle). We’ll pay for your claim from Risk if you visit the trauma unit of a clinic or hospital for emergency treatment such as suturing. We’ll also cover the costs if you visit the trauma unit of a clinic or hospital with a life threatening condition and are admitted immediately for further treatment.

Want to know more? Download our information pack on Fedhealth’s emergency treatment in a casualty ward.

Please note that this benefit is not available on the myFED option.